Online Program

Perceived barriers to care, service utilization, and health in older African American adults living with HIV

Tuesday, November 5, 2013 : 4:45 p.m. - 5:00 p.m.

Sarah K. Calabrese, Ph.D., Yale School of Public Health/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Xindi Fang, B.S., Yale School of Public Health, Yale University, New Haven, CT
Wilson Vincent, Ph.D., Division of Prevention and Community Research, Yale University School of Medicine, New Haven, CT
Rahwa Haile, Ph.D., SUNY Old Westbury/Yale University
Kathleen J. Sikkema, Ph.D., Department of Psychology and Neuroscience, Duke University, Durham, NC
Timothy G. Heckman, Ph.D., College of Public Health, University of Georgia, Athens, GA
Nathan B. Hansen, Ph.D., Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Background: Older African Americans living with HIV represent a growing population in urgent need of affordable and accessible health care services. Understanding barriers to care and their links to health service utilization and clinical health outcomes is necessary. Methods: 136 HIV-positive African Americans ages 50+ completed measures of perceived barriers to care, service utilization (past 4 months), and health (HIV symptoms and physical wellbeing). Regression analyses, controlling for gender, income, age, and time since diagnosis, assessed perceived barriers in relation to service utilization and health, and indirect effects were examined via bootstrapping. Results: Participants reported problems with personal resources (e.g., finances; 77.9%), community stigma (64.0%), geography/distance (37.5%), and healthcare system limitations (e.g., shortage of psychological services; 33.8%) as barriers to care. However, most (89.0%) had recently utilized one or more services, visiting primary care physicians (86.0%), case managers (58.1%), mental health providers (53.7%), medical specialists (25.0%), and/or other care providers (24.3%). On average, participants attended 8 visits in the past 4 months with 3 different types of providers. Among those with scheduled appointments (n = 122), 27.9% failed to attend one or more. Perceived barriers were not significantly associated with number of provider visits, number of provider types seen, or appointment attendance, but were associated with more HIV symptoms and lower physical wellbeing. Service utilization did not mediate the relationship between perceived barriers and health. Conclusions: Structural barriers to care were widely acknowledged as a problem and linked to poorer health. Mechanisms explaining this relationship should be explored and addressed.

Learning Areas:

Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Describe barriers to care and patterns of service utilization among older African American adults living with HIV; Assess barriers to care in relation to service utilization and physical health

Keyword(s): Access to Health Care, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have earned a Ph.D. in clinical psychology and have conducted research focused on HIV treatment adherence and HIV prevention in the Black community. As an NIMH-funded postdoctoral fellow at Yale University's Center for Interdisciplinary Research on AIDS, I continue to conduct research to address racial disparities in HIV prevalence and care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.